A proposed inflammation grading system for laparoscopic cholecystectomy.

BACKGROUND/AIMS: Currently, there is no comprehensive method to classify the inflammatory status of the GB and Calot's triangle.

METHODOLOGY: From 1996, we performed LC on 111 patients with symptomatic gallbladder diseases, irrespective of onset, using an abdominal wall-lifting method. Thirty-six patients had acute cholecystitis, while thirty had chronic cholecystitis. Severe inflammation prompted the author to design a grading system to record inflammatory status and to evaluate the feasibility of LC prospectively. GB with none - mild, moderate, severe wall thickening, and Calot's triangle involvement with mild - moderate, and severe inflammation were classified as Grade I - V, respectively.

RESULTS

Forty-six cases had severe inflammation greater than grade III, however, neither CBD injury nor mortality was experienced. Complications were minimal. Of ten conversion cases (9.0%), eight were grade V, one grade III, and one grade I. Poor laparoscopic view caused by incomplete muscle relaxation accounted for four of the conversions.

CONCLUSIONS

Our grading system is useful in evaluating feasibility of difficult gallbladders, helping to decide conversion during LC, and as a tool to record or elucidate the chronological inflammatory changes of various GB disorders.